MEDICARE: PAT HOLMES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	714273	MO

General Provider Information

NPI Number	:	1831907831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAT HOLMES

Provider Business Mailing Address
First Line	:	140 ELDERBERRY CT
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-7329
Country	:	US
Telephone Number	:	314-574-6326
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 ELDERBERRY CT
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-7329
Country	:	US
Telephone Number	:	314-574-6326
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2024
Last Update Date	:	12/21/2024

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Directions to “ PAT HOLMES ” Practice Location

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